Building a telemedicine app from the ground up: The Dermio story

Telemedicine adoption in healthcare is becoming commonplace. Companies, like MDLive and American Well, are creating national networks. Hospitals and health systems are launching their own services, and entrepreneurial physicians are taking the opportunity to build their telemedicine apps from scratch.

David Soleymani, MD, a private practice dermatologist in Indiana, is one such physician. More than a year ago, he launched Dermio, an app offering consultations with dermatologists online or on iPhones. Starting from his own practice, the app is now available in five states.

Jim Rickards, MD, the former health strategy officer for Yamhill (Ore.) Community Care Organization, took the idea to the west coast by adopting Dermio as project for his MBA coursework. Now, the app is a regular offering at Yamhill CCO.

In an interview with Becker's Hospital Review, Dr. Soleymani described the process of launching the app and what he hopes it will achieve. Dennis Gray, administrator of Yamhill County CCO, shares his organization's experience with the app and the role it has played in expanding patient care in a rural healthcare setting.

Note: Interview has been edited for clarity and concision.

Question: When did you begin to think about starting Dermio?

Dr. David Soleymani: I was practicing at Northwestern [in Chicago] for 10 years, up until last year. During that time, I would encounter patients asking about online visits. I thought myself I was often diagnosing patients within a few seconds on walking into the exam room. Sometimes patients would already know the diagnosis themselves, acne for example.

After putting effort into the idea, I thought about the people in underserved areas with no access to dermatology care. They either deal with their condition or even end up in the emergency department. If the app branched out, it could help fill an unmet need in rural communities.

We are not looking to replace in-person dermatology visits. Dermio is meant to be supplemental. I am looking to solve a supply and demand issue. In a lot of areas, this app will be the only thing people will be able to access.

We looked at 2011 Medicare data for patients who ended up in the emergency department for a dermatology issue. There were $2.64 billion spent on non-dermatologists addressing dermatology needs. With the current climate and people thinking about healthcare expenditures, Dermio is an obvious solution. This solution can be implemented and save the healthcare system money.

Q: How long did it take to build the app from concept to reality?

DS: I knew I didn't want to be employed any longer. I wanted to go off on my own and focus on the app. Chicago is a saturated market. I went back to northwest Indiana to begin a private practice. I am not yet at full capacity in my practice, but Dermio has already created a bit of buzz. This isn't like Chicago; there aren't dermatologists all over the place. There are people struggling with major and dermatological conditions here. We have gotten press.

Q: How does Dermio work?

DS: There are two sides to the app. On the consumer side of the app, users are able to pay via credit card. Primary care clinics in rural underserved areas can access the clinical side of the app. It takes about three minutes to take photos, answer demographic questions and submit a consult. The results will be delivered within 24 hours.

Q: What areas does Dermio serve?

DS: Dermio is licensed for use in five states: California, Illinois, Indiana, Oregon and Washington.

Q: How did you expand Dermio beyond your own practice?

DS: I had friend a (Dr. Rickards) move out to Oregon to get his MBA. He used the app as part of his project. The need for dermatologists was recognized out there.

Q: Are you planning to expand the app?

DS: I don't have plans to have Dermio branch out beyond dermatology, but there are plans to add features. We would like to add live video visits to make the app more interactive.

Q: How did Yamhill Community Care Organization first form a relationship with Dermio?

Dennis Gray: The app was introduced to us by Dr. Rickards. Yamhill CCO then contracted with Dermio to provide teledermatology. We have been using the app for about 18 months. We adopted the technology because it works really well with the existing workflow. Right now, the app services our Medicaid population.

Q: Is this the first time Yamhill CCO has used telemedicine?

DG: This is our first telemedicine project, but we are looking at other programs. Right now, telemedicine for psychiatry is appealing. It's difficult to have access to physicians for mental illness in rural areas, but patients need physicians to manage these conditions.

Q: What kind of feedback have you received from providers using Dermio?

DG: Our doctors and patients are really happy with it. There isn't an outlet for dermatology here. Normally, we would have to send patients to Portland. We have quite a bit of success in either confirming primary care provider diagnoses or identifying diseases PCPs may not have been able to recognize.

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